February 4, 2003

     Congratulations! You are about to become a full-pledged doctor and alumnus. Welcome to the fields, both barren and ripe in places. You now face being the professional you were trained to be, or join the ranks of the poor and jobless.

     It is just about one month away from the end of the line: medical school graduation. In one month, there will be a new batch of doctors out there: green, idealistic, and roaring to go. The path has been long and hard so far: 8 years of premed and medicine. It was not easy, and only the tough and the committed survive. Unless one chose to be a doctor, had the resources to set him or her up, and had the will to tough it out, one cannot achieve adding those two bold letters after his name: “M.D.”

     So what comes after med school? Inevitably it is postgraduate internship (PGI), then the Boards, then Residency or general practice. For the residents, the next step may be a Fellowship, or practice. There is a never-ending succession of goals to hurdle in becoming a doctor, but when you become one, it is never an assurance of success.

     Well, at least you had that pride of achievement, or the so-called prestige of the class. Whatever.

     By now, your High School batch mates who chose “lesser professions” are actually richer than you are, have their own cars and offices, while you labor every other night “On Duty” paid with poverty level salary. At the same time, you are studying for the Boards, or Residency exams or Diplomate credentialing while your other same-aged buddies go out drinking in the karaoke and having their cars polished in the bikini car wash.

     No wonder after getting that MD degree, many doctors choose rather to become businessmen, earning more in their pharmacies, farmland, stocks or political pursuits. It is no assurance indeed that there are riches after graduation, if you indeed pursue a career consistent with the degree. A friend and a fellow doctor told me that nowadays, if you want to be a rich doctor, the best thing to do is to marry a rich spouse.

     First, you have to establish a practice. The most important factor in this choice is LOCATION. Where do you want to practice your trade? It may be nice to work in the city or big town. You have to ask yourself, “How many other specialists are in the area and how many people live in that geographical spot that may actually seek my consultation?” You may face tough competition and more often than not, the competition will be your own mentors, who have established clientele years before you were born. In the field, you are but another small fish competing with the sharks for the little fish fry. You’ll be lucky if you only have a herbolario or serohuano to compete with.

     But, if you relocate to the boonies, your earning may be even more meager. It is somewhat patriotic and touching to go back to your roots and practice in your little hometown that does not have enough physicians yet, if you truly want to serve. It is commendable, as long as you have no problem with freebie consults, or payments with mangoes, chickens and bananas. Also, you may need to include in your budget the rebels holed out in the mountain just behind your shanty-clinic out there. If you are friends with them, then no problem! You may even get to treat gunshot wounds as a Psychiatrist. Then of course, there is the issue of resources. If our city hospitals are ill equipped, what shall you work with in the hinterlands? Where is the nearest X-ray, laboratory, hospital or druggist? If there are no such resources, be prepared to use an extreme “clinical eye” and take the risks of misdiagnosis and delayed or wrong treatment. You need to know also when and whom to refer to, and where the other specialists are that you may need to send patients to. Hopefully, a fellow alumnus or classmate is in the neighboring sitio.

     One great option is to join a Department of Health program and be a doctor to the barrios, as some of our alumni did. Previous articles have featured an alumna or two who gave up a huge deal to serve the masses. The pay is not the best but it is quite okay, and there are government related benefits. You can also become a medical examiner or join the ranks of the armed forces or police medical corps. For these, however, sometimes you may need to develop premature cataracts to be able to bear seeing the rampant corruption you may be tempted to condone or join in with.

     Then of course, you may be lucky enough to join a big practice in some big hospital in some big city. Good, but do not leave your conscience behind. Before you sign anything, make sure you look at the contract very closely so that you get a decent chunk of the profits, and not get abused as the lowest man in the totem pole. Wherever you are, it would also be best to get malpractice/liability insurance. If you don’t know why, you’re a dummy and need to read all of Rolour’s articles in the past few months.

     You can also opt for more training. Specialize, sub-specialize, and supersubspecialize. One patient commented once that one day, there would be different surgical specialties for each hand and each finger. This does not only mean continuing medical education, but going to fellowship. Yes, the pay sucks, and your field will narrow down further. Perhaps just to buy time and potentially get a bigger paying specialty. Don’t train for a field if you don’t like it, please, for the patient’s sake.

     Lastly, there is the overseas option. You can practice medicine anywhere in the world where there is reciprocity, like in the USA and many other countries. The pay is probably better, the issues way different and the challenges a world apart. If you want to know how to come and practice here, email me or access the US immigration website and look at the J1 section. Unless you marry an American or “green card holder”, you can only hope to practice here as a J1--the worst visa you can get if you want to stay after completing (or repeating) residency training. It is very expensive to apply, and the process and exams difficult. You will not be serving your countrymen too, except by sending dollars back to the motherland. So congratulations again on completing med school or training. Welcome to the real world.

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     The author's e-mail address is at docdan1@pol.net.

     Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members. For comments, please e-mail the author.